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Evidence to Improve Care

Diabetic Foot Ulcers

Care for Patients in All Settings

Click below to see a list of brief quality statements and scroll down for more information.​​


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.​


Quality Statement 1: Risk Assessment
People with diabetes are assessed for their risk of developing a diabetic foot ulcer when they are diagnosed with diabetes and at least once a year thereafter. Patients at higher risk are assessed more frequently. All risk assessments are performed using standard, validated tools.


Quality Statement 2: Patient Education and Self-Management
People with diabetes and their families or caregivers are offered education about diabetic foot care and complications, including basic foot care; how to prevent foot complications and monitor for the signs and symptoms of foot complications; and who to contact in the event of a concerning change.


Quality Statement 3: Referral to an Interprofessional Team
le with a diabetic foot ulcer are referred to an interprofessional team that delivers ongoing, coordinated, integrated care. If they have major complications, they are seen within 24 hours by a team that delivers emergency services and then referred to an interprofessional team for ongoing care.


Quality Statement 4: Comprehensive Assessment
People with a diabetic foot ulcer or foot complications undergo a comprehensive assessment that informs their individualized care plan and includes evaluation of vascular status, the presence of infection, and pressure redistribution to determine the healing potential of the wound.


Quality Statement 5: Individualized Care Plan
People with a diabetic foot ulcer or foot complications have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


Quality Statement 6: Pressure Redistribution
People with a diabetic foot ulcer or foot complications are offered pressure-redistribution devices as part of their individualized care plan.


Quality Statement 7: Wound Debridement
People with a diabetic foot ulcer have their wound debrided if it is determined as necessary in their assessment, and if it is not contraindicated. Debridement is carried out by a trained health care professional using an appropriate method.


Quality Statement 8: Local Infection Management
People with a diabetic foot ulcer and a local infection receive appropriate treatment, including antimicrobial and non-antimicrobial interventions.


Quality Statement 9: Deep/Surrounding Tissue Infection or Systemic Infection Management
People with a diabetic foot ulcer and a suspected deep/surrounding tissue infection or systemic infection receive urgent assessment (within 24 hours of initiation of care) and systemic antimicrobial treatment.


Quality Statement 10: Wound Moisture Management
People with a diabetic foot ulcer receive wound care that maintains the appropriate moisture balance or moisture reduction in the wound bed.


Quality Statement 11: Health Care Provider Training and Education
People who have developed or are at risk of developing a diabetic foot ulcer or foot complications receive care from health care providers with training and education in the assessment and management of diabetic foot ulcers and foot complications.


Quality Statement 12: Transitions in Care
People with a diabetic foot ulcer or foot complications who transition between care settings have a team or provider who is accountable for coordination and communication to ensure the effective transfer of information related to their care.

5

Individualized Care Plan

People with a diabetic foot ulcer or foot complications have a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


An individualized care plan guides effective, integrated coordination and delivery of care. Consideration of factors that may affect the healing potential of the wound (ulcers may be healable, maintenance, or non-healable—see Quality Statement 4 for definitions) is essential for optimizing healing conditions and quality of life. These factors include wound characteristics such as necrosis, infection, or vascular supply; individual characteristics such as comorbidities, cognitive impairment, or adherence to the care plan; and environmental or socioeconomic characteristics such as access to services or needed pressure-redistribution devices (including the ability to pay for those devices).

The inclusion of mutually agreed-upon goals enables the health care team to review and monitor the person’s progress over time and adjust treatment plans based on what is working well and what should be discontinued. Regular review of the care plan also provides an opportunity to repeat aspects of the comprehensive assessment, revisit goals, review progress, and make adjustments based on the changing needs and preferences of the person receiving care.

For Patients

Your health care professional should work with you to develop a care plan that reflects your needs, concerns, and preferences. A care plan is a written document that you have developed with your health care professional. It describes your goals for your care, the care you will receive, and who will provide it.


For Clinicians

Work with people who have a diabetic foot ulcer or foot complications to create a mutually agreed-upon individualized care plan that identifies patient-centred concerns and is reviewed and updated regularly.


For Health Services

Ensure that systems, processes, and resources are in place to support clinicians in developing individualized care plans for people with a diabetic foot ulcer or foot complications. This may also include tools such as standardized care plan templates.

Process Indicators

Percentage of people with a diabetic foot ulcer or foot complications who have a mutually agreed-upon individualized care plan that identifies patient-centred concerns

  • Denominator: number of people with a diabetic foot ulcer or foot complications

  • Numerator: number of people in the denominator who have a mutually agreed-upon individualized care plan that identifies patient-centred concerns

  • Data source: local data collection

Percentage of people with a diabetic foot ulcer or foot complications who have had their care plan reviewed and updated regularly

  • Denominator: number of people with a diabetic foot ulcer or foot complications

  • Numerator: number of people in the denominator who have had their care plan reviewed and updated regularly (frequency may range from daily to every 3 months)

  • Data source: local data collection

  • Potential stratification: healable, maintenance, or non-healable ulcer

Foot complications

These include factors that may lead to soft-tissue breakdown and ulceration, such as dry skin, callus, blister, deformities, minor fractures, and subacute Charcot arthropathy.

Individualized care plan

This includes:

  • Results of the comprehensive assessment (see Quality Statement 4), including risk factors and the dimensions, characteristics, and healing trajectory of the ulcer
  • Education (see Quality Statement 2)
  • Mutually agreed-upon goals of care based on individual concerns and preferences
  • Factors that may affect wound healing, and patient-centred concerns such as pain management, optimizing activities of daily living, and psychosocial needs and supports
  • A plan for local wound care based on the healing potential of the wound, which may include the following:
    • Pressure redistribution and appropriate footwear
    • Infection management (localized, deep/surrounding tissue, and systemic infection)
    • Debridement
    • Dressings and moisture balance
    • Strategies for preventing recurrence

Reviewed and updated regularly

Frequency may range from daily (during dressing changes and based on regular wound assessments) to weekly (if cast changes are needed) to every 1 to 3 months (for a full care plan review) and is based on the characteristics of the wound, the acuity of the foot problem, and whether or not there are significant changes. Reviewing the care plan may require a partial reassessment (repeating aspects of the comprehensive assessment) or a full reassessment, including revisiting the goals of care.

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